CONSTRUCTION JOB SELF-INSPECTION FORM

Person conducting inspection_________________________________________Date of inspection______________

Job___________________________________________Location________________________________________

Description of job______________________________________________________________________________

EXPOSURES                      N/A         Sat.         Needs
                                                                            Action	EQUIPMENT                     N/A         Sat.        Needs
                                                                           Action	
1. Job site protection                        ____          ____            ____
2. Bldg. perimeter guarded               ____          ____            ____
3. Floor and roof openings guarded  ____          ____            ____
4.Adjacent properties                        ____          ____            ____
5. Fire protection                               ____          ____            ____
6.Traffic control and posting             ____          ____            ____
7.Compressed gas cylinders              ____          ____            ____
8. Flammables                                   ____          ____            ____
9. Blasting                                         ____          ____            ____
10. Lasers                                          ____          ____            ____
11. Excavation /Trenching                ____          ____            ____
12. Underground                               ____          ____            ____
13. Demolition                                  ____          ____            ____
14. _____________                          ____          ____            ____	15. Ladders                                       ____          ____            ____
16. Scaffolds                                     ____          ____            ____
17. Material Hoists                           ____          ____            ____
18. Manhoists                                   ____          ____            ____
19. Rampways                                   ____          ____            ____
20. Shoring                                        ____          ____            ____
21. Power tools                                  ____          ____            ____
22..Hand tools                                   ____          ____            ____
23..Salamanders                                ____          ____            ____
24. Equipment guards                       ____          ____            ____
25. Equipment maintenance              ____          ____            ____
26. Operating rules posted                 ____          ____            ____
27. Cranes/Booms                              ____          ____            ____	
PERSONAL                        N/A         Sat.         Needs
PROTECTIVE EQUIP.                                    Action	HOUSEKEEPING.            N/A         Sat.        Needs
                                                                           Action	
28. Hard hats                                   ____          ____            ____
29. Safety shoes                               ____          ____            ____
30. Safety glasses                            ____          ____            ____
31. Gloves                                       ____          ____            ____
32. Lifelines                                    ____          ____            ____
33. Safety nets                                 ____          ____            ____
34. Hearing protection                     ____          ____            ____
35. Rain gear                                    ____          ____            ____
36. Safety signs posted                     ____          ____            ____
37. Illumination                                ____          ____            ____
38. Ventilation                                  ____          ____            ____
39. _______________                     ____          ____            ____	40. Debris cleanup                           ____          ____            ____
41. Debris removal                           ____          ____            ____
42. Material storage                          ____          ____            ____

Miscellaneous
43. Access to jobs                             ____          ____            ____
44. Nails in lumber                            ____          ____            ____
45. Protruding rods or wire                ____          ____            ____
46. Form stripping                              ____          ____            ____
47. Electrical wiring                            ____          ____            ____
48. ________________                       ____          ____            ____
49. ________________                       ____          ____            ____	
MANAGEMENT                 Sat.            Needs Action	RECOMMENDATIONS	
50. Accident investigation                 ____               _____
51. Job site safety meetings               ____                _____
52. First Aid                                      ____                _____
53. Adequate supervision                  ____                _____
54. Control of subs                            ____                _____
55. ____________________            ____                _____	No recommendations                                                        _____
Recommendations listed below                                         _____

Recommendations discussed                                             _____
Recommendations not discussed                                       _____

In compliance                                                                     _____	
RECOMMENDATIONS:___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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